Book Review
AIDS 
The Psychiatry of AIDS:
A Guide to Diagnosis and Treatment Glenn J Treisman, Andrew F Angelino. Baltimore (MD): Johns Hopkins
University Press; 2004. 217 p. US$19.95.
Reviewer
rating*: Excellent
Review by: Marie-Josée Brouillette, MD, FRCPC
Montreal, Quebec
This book’s author, Dr Glenn Treisman, has led the Psychiatric Services for the Johns Hopkins HIV/AIDS Care Program for more than 12 years, while its coauthor, Dr Andrew Angelino, has broad experience in the field.
The preface, by Dr Treisman, sets the tone. He acknowledges the work of his colleagues with profound understanding, stating, for example, “These are the trenches . . . these clinicians have waded into the mud of psychiatric illness and dragged patients out one at a time” (p xii). The book is upbeat and optimistic, yet realistic and deeply human.
There are 9 chapters: “Why AIDS Psychiatry?” “HIV and Major Depression,” “Other Psychiatric Diseases in the HIV Clinic (including AIDS dementia),” “Personality in the HIV Clinic,” “Substance Abuse and HIV,” “Sexual Problems and HIV,” “Life Story Problems in the HIV Clinic,” “Special Problems: Hepatitis C and Adherence,” and “How to Fight AIDS.” These are interspersed with case studies that illustrate and bring to life the didactic material.
The authors approach the topic of each chapter by focusing on how clinicians can understand the psychiatric condition in a way that opens new therapeutic possibilities rather than one that fosters pessimism. The paradigms discussed are refreshing and enlightening. For example, in discussing substance abuse, the authors explore the inherent reinforcing properties of the substance but also raise the questions of why, if these substances are reinforcing, does not everyone who experiments with them become addicted? Why do some people not become addicted?
Without specifically promoting gentle (and sometimes not so gentle) confrontation, this is clearly the favoured approach in the context of a supportive relationship. While this straight-talk style may not suit the personality of every clinician, the examples do debunk the myth that confrontation will inevitably hurt the therapeutic alliance. For example, consider the following exchange:
“Why did you miss your last appointment here at the clinic?”
“It was snowing.”
“Would you have gone out to ‘cop’ if you were using?”
“Of course.”
“Well, you have to be willing to go out in worse weather to get sober than you would to ‘cop,’ because it is harder to get sober than to stay an addict” (p xiii).
The difficulties encountered by medical personnel in treating HIV in the presence of psychiatric comorbidity are amply explored; ways in which the relationship can be supported through interventions with both patients and members of the medical team are suggested in several illustrative cases. In my experience, this is a crucial aspect of providing psychiatric consultation in an HIV clinic: it decreases staff frustration and burn-out and consequent disruptive staff turnover, while also limiting the destructive dynamic of the unpleasant-to-treat patient being tacitly encouraged to discontinue treatment and disappear.
The target readers are both HIV–AIDS professionals and mental health experts. For that reason, psychiatrists may find some of the information too basic and may decide to skip over some sections.
The book is not a literature review but rather a presentation of paradigms that have been found to be useful. Nevertheless, one sometimes wonders whether this approach is carried too far and focuses on the author’s idiosyncratic interest. For example, the chapter on “Personality in the HIV Clinic” is built around the introversion–extraversion dimension of temperament. Other approaches could have been presented as well, drawing, for example, from the literature on the treatment of patients with borderline personality disorders.
In addition, the crucial information acquired here would be best complemented by another, more comprehensive source of factual information. For example, in the discussion of AIDS dementia, the impact of executive dysfunction (the main type of cognitive impairment found in AIDS dementia) on the capacity for independent living is not discussed. Similarly, the section on methadone does not mention the clinically problematic interactions with several antiretrovirals; a clinician prescribing disulfiram needs to know that alcohol is present in the liquid form of one of the antiretrovirals.
In conclusion, this book is well worth reading. It contains the wisdom usually transmitted by an experienced supervisor who works in this difficult field, loves it, and is always looking for new approaches that will improve outcomes. It is informative, energizing, and inspiring.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
|
